Acute Myocardial Infarction Caused by Oral-Contraceptive – Related Spontaneous Coronary Artery Dissection: a Case Report

Key findings from this study

• The study found that a 32-year-old woman on combined oral contraceptives for four months developed acute myocardial infarction secondary to spontaneous coronary artery dissection.
• The authors report that intracoronary nitroglycerin administration and follow-up optical coherence tomography enabled diagnosis and documentation of intramural hematoma.
• The researchers demonstrate that conservative management resulted in complete recovery with restoration of left ventricular function at one-year follow-up.

Overview

Spontaneous coronary artery dissection (SCAD) represents an increasingly recognized etiology of acute myocardial infarction in young women. Hormonal factors, particularly combined oral contraceptive use, may constitute a significant pathophysiological mechanism. This case report documents a 32-year-old woman who developed acute myocardial infarction attributed to SCAD four months after initiating oral contraceptive therapy.

Methods and approach

The patient underwent coronary angiography following presentation with acute ST-segment elevation myocardial infarction. Intracoronary nitroglycerin administration was performed during the acute phase. Follow-up optical coherence tomography imaging at six weeks provided structural confirmation of the dissection diagnosis.

Results

Coronary angiography identified diffuse left anterior descending artery narrowing with subsequent improvement following intracoronary nitroglycerin administration. Optical coherence tomography obtained at six-week follow-up confirmed intramural hematoma consistent with SCAD pathology. Conservative management was selected rather than revascularization. Clinical recovery occurred with normalized left ventricular function at one-year follow-up.

Implications

Early recognition of SCAD as a distinct pathophysiological entity in young women with acute coronary presentations remains essential for appropriate clinical management. Identification of oral contraceptive use as a potential precipitant warrants heightened clinical suspicion in this demographic. Advanced imaging techniques such as optical coherence tomography facilitate diagnostic confirmation and may inform decisions regarding interventional versus conservative management strategies.

Scope and limitations

This summary is based on the study abstract and available metadata. It does not include a full analysis of the complete paper, supplementary materials, or underlying datasets unless explicitly stated. Findings should be interpreted in the context of the original publication.